Commentary: Now Is the Time to Safeguard Access to EC before Abortion Restrictions Sweep the United States
This commentary, written by ASEC in collaboration with a diverse team from across the country, describes the increasing importance of contraception, particularly emergency contraception, as 26 states are likely to severely restrict access to abortion following the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, access to emergency contraception will be more important than ever. Existing barriers to emergency contraception – including cost, obstacles to over-the-counter purchase, low awareness and availability of the most effective options, myths about safety and mechanism of action – already substantially limit access. Proactive solutions include public information campaigns; healthcare provider education about all emergency contraceptive options, including IUDs and advance provision of emergency contraceptive pills; innovative service delivery options such as vending machines and community distribution programs; and policy initiatives to ensure insurance coverage, eliminate pharmacy refusals, and support all service delivery options. In the face of extreme limits on reproductive healthcare, now is the time to expand and protect access to emergency contraception so that everyone has the possibility of preventing pregnancy after unprotected sex or sexual assault.
Mechanism of Action of Levonorgestrel ECPs
The mechanism of action of emergency contraceptive pills (ECPs) has been a source of confusion since the introduction of ECPs. The FDA-approved label for levonorgestrel ECPs includes a hypothetical mechanism of action suggesting that it may prevent implantation of a fertilized egg in the uterus. A substantial body of evidence indicates that levonorgestrel (LNG) ECPs work primarily – and perhaps exclusively – by delaying or inhibiting ovulation and have no effect once ovulation is imminent. Based on the evidence the European Medicines Agency removed language suggesting an effect on implantation from the LNG label in 2013, yet this language remains on the US labels. Policy makers and courts in the United States and elsewhere have used this hypothetical mechanism to restrict access to ECPs. This fact sheet describes the scientific research documenting the mechanism of action of LNG ECPs.
EC Efficacy and Weight
Recent regulatory changes have raised the question of whether ECPs may be less effective for users with higher body weights. Some data show that both LNG (sold in the US as Plan B One-Step®, Take Action™, and others) and UPA (sold in the US as ella®) may be less effective for individuals with higher body weight, although LNG may lose effectiveness at a lower weight threshold than UPA. However, there is disagreement about whether these data are definitive. New evidence calls into question previous recommendations to offer a double dose (3.0 mg) of LNG EC to individuals with obese body mass index.
EC in the COVID Era
The rapid spread of COVID-19 has highlighted fundamental gaps in the American healthcare system, weaknesses in our social fabric, and striking racial and economic disparities. Access to reproductive healthcare is as essential as ever, yet the pandemic layers new barriers upon existing challenges. Now more than ever, emergency contraception (EC) is an important option for individuals who want to prevent pregnancy on their own terms. Having EC on hand before it is needed can make that a possibility any time, but particularly during this crisis. In this fact sheet, we describe the importance of EC during this crisis and recommend strategies for obtaining a supply of EC pills to keep on hand before it is needed.
EC for Transgender Patients
Healthcare providers who offer care for patients of reproductive age should be ready to answer questions about EC for transgender and nonbinary patients. Pregnancy is possible for any individual with a uterus and ovary(ies) who has receptive penis-in-vagina sex with partners who produce sperm, regardless of gender identity. Patients who are amenorrheic due to testosterone use may be surprised that they may be at risk for pregnancy. Transgender and nonbinary people deserve patient-centered access to the full range of reproductive healthcare options, including EC. Healthcare providers have an important role to play in offering supportive, non-judgmental, and compassionate care. This fact sheet addresses medical and social-emotional aspects of EC for transgender and nonbinary patients.
Emergency Contraception: A guide for Pharmacies and Retailers
In partnership with the Birth Control Pharmacist, this factsheet highlights important information about emergency contraception, purchasing restrictions, why it's importance to stock LNG-EC, and the available FDA approved emergency contraceptives. Para una versión en español, haga clic aquí.
Providing Hormonal Contraception after Use of EC Pills
Until recently, clinical guidelines recommended immediate start of ongoing hormonal contraception after use of any EC pills to reduce the future risk of pregnancy. However, recent evidence suggests that providing progestin-containing contraceptives after ulipristal acetate (UPA) EC may reduce the efficacy of UPA EC. In this extensively reviewed fact sheet, we describe the evidence, discuss outstanding questions, and offer recommendations for providers.